Sepsis emergency. A high-risk crisis.
A Recent Experience Visiting the Emergency Room
As I’ve been working to help get GeriScope up and running, my dad decided to get really sick. I called him on Monday morning to chat as he was supposed to be going to a grave side service for another family member. He complained of severe back pain that made it very difficult for him to do anything other than remain still. After three days of pain and his decision to stop eating and drinking, my stepmother became extremely concerned and called an ambulance because dad was also acting somewhat disoriented.
Upon arrival to the emergency room (ER), the medical team did a quick assessment of my father which included vital signs, electrocardiogram (EKG), and blood work. Because his blood pressure was very low, they started Intravenous (IV) therapy to replace lost fluids while searching for the underlying cause. It soon became apparent that dad was actually pretty sick and getting worse.
They diagnosed him with a urinary tract infection that progressed to the point of him developing sepsis – a potentially life threatening condition caused by the body’s huge release of chemicals to combat an infection. When the amount of chemicals is too great, then there is the potential to damage multiple organ systems. If sepsis becomes septic shock, then one’s blood pressure drops dramatically, which was what he was experiencing. Dad ended up in the Intensive Care Unit (ICU) for a few days because his kidneys were failing and he needed medication to keep his blood pressure up. Thankfully, he responded to treatment and has subsequently been discharged to a rehabilitation hospital so he can regain his strength and get reconditioned to go home again.
This is a great example what we are trying to do with GeriScope – give loved ones the information they need to respond to health emergencies. My father is 83 and this could have been a tragic struggle at every step, but my experience as a physician and with my mother’s illness made it much more manageable.
Lessons Learned and Things You Can Do
The first thing I did when my mother passed away was have the “The Talk” with my father so we would know the answers to these questions:
What do you want us to do if you get really sick and can’t tell us what you want? Do you want to be kept alive with drugs and/or a breathing machine? I knew, even at 83, he would want everything done to keep him alive. What’s your medical history including medications, allergies, and past surgeries? The easiest and best thing to do is to write these things down and keep the lists with you at all times. What insurance do you have to cover health care expenses? He was a superintendent of schools in New York City so he had supplemental private insurance along with his Medicare and robust long term care coverage.
The benefit of having The Talk was that when they went to the ER, my stepmother was able to provide a detailed account of what had been going on the last few days and all of his past medical history. This made it easier to diagnose and treat his problems.
What to Expect in the Emergency Room
When any of our loved ones end up in the ER, you can always expect a few things to happen.
First, the staff and all of the physicians will likely ask you the same questions repeatedly! This may seem like they’re not very coordinated but the most important first step is to gather as much accurate information as possible. You would be absolutely shocked at how many times a patient or their family will give you different answers or the same question. I have gone in to interview a patient after several other nurses or physicians and asked about something like chest pressure instead of chest pain and gotten a long history of what is probably heart disease. Because they never actually complained of chest pain, they denied having heart disease, but chest pressure is definitely an indication of potential heart disease!
Secondly, they will also check vital signs (body temperature, pulse and respiration rate, and blood pressure) blood sugar, mental status, and order an EKG. These tests will help the medical team discover or rule out any life threatening conditions like a heart attack or stroke. That first assessment will often lead to imaging like a chest X-ray and/or more detailed computerized tomography (CT) scan and magnetic resonance imaging (MRI) that provide cross-sectional view of the bones, blood vessels, soft tissues and physiological processes inside the body. My father’s back pain prompted a CT scan and MRI of his back.
Thirdly, once tests are done, the medical team will evaluate the results. If it doesn’t look like your loved one is in immediate danger, it may take a few hours for the physician to evaluate the results and decide on a treatment plan which may include being admitted to the hospital.
The ER can be an uncomfortable and draining environment as everyone is there with some sort of urgent medical issue. Be patient but also do your best to stay engaged with the ER staff and physicians. Ask EVERY question you have. If they seemed annoyed, ask more questions. Good information usually makes everyone more comfortable. Don’t be afraid to ask for updates. In the end, you want your family member to receive the best care possible. Just in case you may want to review the hospital visit checklist to make sure you bring along some things to help you while you wait.